In this report, you'll find the high level trends and themes from the last three months of our analysis of CQC GP Practice Inspection Reports. Here you can see what most commonly led to practices being awarded Outstanding, Requires Improvement, and Inadequate. You can also see the trends broken down by Key Question, and some thoughts on practical implications for GP practice and PCN managers.

Reports covered: July: 2 Outstanding and 4 Requires Improvement reports; August: 4 Requires Improvement reports; September: 1 Outstanding, 4 Requires Improvement and 1 Inadequate report.

Executive summary

Across this quarter, the strongest message from Outstanding-rated practices is that they are increasingly demonstrating a combination of proactive population health management, community engagement, innovation and highly structured governance. The most highly praised organisations were not simply providing accessible GP services. They were actively identifying risk, redesigning pathways, building partnerships, addressing health inequalities and demonstrating measurable outcomes.

By contrast, Requires Improvement and Inadequate reports repeatedly highlighted failures in basic governance, safety oversight and operational control. Common concerns included poor learning from incidents, safeguarding weaknesses, inadequate monitoring of high-risk medicines, recruitment and training gaps, poor infection prevention arrangements, fire and premises safety failures, weak documentation, inadequate follow-up systems and leadership teams that lacked oversight of key risks.

A notable theme during this quarter is that many low-rated practices were criticised not for isolated errors, but because leaders could not demonstrate reliable systems to identify problems, monitor performance and sustain improvement. Repeated regulatory breaches, unresolved risks and poor governance arrangements featured heavily throughout the reports.

1. Trends from the Outstanding rating reports

1. Prevention, population health and proactive case-finding continue to define Outstanding practice

One of the clearest themes throughout the quarter was a proactive approach to identifying health risks before they become serious problems.

Outstanding practices demonstrated sophisticated approaches to hypertension management, diabetes engagement, immunisation improvement, chronic kidney disease detection and support for high-frequency service users. Rather than waiting for patients to seek help, practices actively searched records, stratified risk and targeted interventions at patients most likely to benefit.

Examples included virtual hypertension clinics, targeted diabetes initiatives, chronic kidney disease coding audits, structured mortality reviews and programmes designed to identify frequent attenders and address underlying causes of repeated presentations.

The message for GP and PCN leaders is clear: CQC continues to place significant value on proactive population health management supported by evidence, data and measurable outcomes.

2. Community engagement and tackling health inequalities are increasingly prominent Outstanding themes

Outstanding practices demonstrated innovative approaches including community health hubs, migrant support services, digital inclusion programmes, sports academies aimed at reducing childhood obesity, outreach activities, social wellbeing programmes and targeted support for underserved communities.

Several services demonstrated an understanding that improving health outcomes often requires addressing housing, financial hardship, social isolation, language barriers and digital exclusion alongside clinical care.

September’s Outstanding report particularly highlighted the value of social prescribing and community-based support, including social day units, bereavement groups, support for isolated individuals and services designed specifically for vulnerable populations.

These examples suggest that CQC increasingly values practices that view themselves as community anchors, rather than solely healthcare providers.

3. Personalised care for vulnerable groups is a recurring marker of excellence

Outstanding practices consistently adapted services around specific patient needs. Examples included autism-friendly practice models, learning disability health check clinics, dedicated migrant support, sheltered accommodation clinics, sensory support tools, priority access schemes, dementia care planning and support for carers.

Several practices demonstrated extensive efforts to remove barriers to care and create tailored pathways for groups that may otherwise experience poorer outcomes.

The strongest examples were not one-off initiatives. They were embedded into routine systems, staff training, digital records and governance processes.

This reinforces a continuing trend that CQC is looking beyond equality policies and seeking evidence that services have actively redesigned care around population needs.

4. Strong partnership working continues to distinguish Outstanding services

Partnership working featured repeatedly throughout the quarter.

Outstanding examples included collaboration with Primary Care Networks, Integrated Care Boards, hospitals, youth services, social care organisations, community groups, autism services, voluntary sector organisations and research networks.

The best examples produced tangible outcomes such as integrated adolescent services, single referral pathways, social prescribing programmes, cancer pathways, community wellbeing hubs and specialised support for vulnerable populations.

For managers, the lesson is that partnership working is most effective when it delivers practical benefits for patients and measurable improvements in outcomes.

5. Learning cultures and governance systems are becoming increasingly sophisticated

A major Outstanding theme was the existence of mature governance frameworks. Examples included comprehensive significant event processes, live risk registers, structured governance meetings, end-of-day operational reports, quality and safety forums, audit cycles and transparent learning systems.

The strongest organisations demonstrated that governance was embedded into everyday operations rather than treated as a compliance exercise. These practices could clearly show how incidents, complaints, audits and performance data resulted in action, learning and measurable improvement.

6. Staff wellbeing, culture and leadership remain defining Outstanding characteristics

Outstanding practices consistently demonstrated positive workplace cultures. Examples included wellbeing initiatives, leadership development, inclusive policies, menopause support, support for neurodiverse staff, protected development time, staff engagement programmes and strong supervision arrangements.

Importantly, CQC’s praise was not simply about staff satisfaction. Positive cultures were linked to patient outcomes, sustainability, retention, safety and organisational resilience.

The strongest leadership examples combined compassion with structure, demonstrating clear accountability, transparency and continuous improvement.

2. Trends from the Requires Improvement and Inadequate reports

1. Weak governance remains the most consistent cause of poor ratings

The dominant theme across July, August and September was ineffective governance. Repeated concerns included poor oversight of risks, weak monitoring systems, incomplete meeting records, lack of action tracking, ineffective audits, poor recruitment governance, inadequate training oversight and failures to learn from incidents.

Many practices had policies, procedures and meetings in place, but could not demonstrate that these systems were functioning effectively.

Several reports described recurring issues previously identified by CQC that had not been resolved.

This quarter strongly reinforces the message that governance failures are often the root cause behind wider safety and quality concerns.

2. Learning from incidents and complaints remains a major weakness

One of the most repeated themes was poor organisational learning. Low-rated practices frequently recorded complaints and incidents but failed to demonstrate meaningful analysis, dissemination of learning or implementation of improvements.

Several reports described ineffective significant event processes, poor documentation, limited staff involvement and recurring issues that continued despite previous warnings.

In multiple cases, learning systems appeared focused on recording events rather than changing practice.

The recurring lesson is that CQC expects organisations to evidence a closed-loop learning process from identification through to measurable improvement.

3. Medicines management remains one of the highest-risk operational areas

Medicines optimisation featured prominently across all three months. Recurring concerns included inadequate monitoring of high-risk medicines, ineffective recall systems, failure to act on MHRA alerts, poor vaccine management, cold-chain failures, expired medicines, inadequate medicine reviews and weaknesses in prescription security.

Many practices were criticised not because monitoring systems were absent, but because leaders could not demonstrate that patients requiring monitoring were consistently identified and followed up.

This remains one of the clearest operational priorities for GP providers.

4. Safeguarding governance is frequently inadequate

Safeguarding concerns appeared repeatedly throughout the quarter. Examples included incomplete training, lack of vulnerable patient registers, poor coding, ineffective oversight, absent audits, weak governance arrangements and limited evidence of learning or trend analysis.

Several reports suggested safeguarding activity was occurring but was not being monitored, reviewed or evidenced effectively.

The message remains consistent: safeguarding must be visible, auditable, coded, monitored and routinely discussed.

5. Premises, fire safety and infection control continue to generate significant concerns

August and September particularly highlighted environmental safety failures. Recurring issues included overdue fire safety actions, incomplete fire training, Legionella concerns, poor water monitoring, weak COSHH arrangements, inadequate cleaning systems, expired consumables, poor waste management, damaged flooring and ineffective infection control governance.

Several practices also struggled to obtain assurance over landlord-controlled safety arrangements.

The practical lesson is that environmental safety remains a major source of regulatory risk and requires active management rather than passive reliance on external providers.

6. Staffing, recruitment and training weaknesses remain common

Many low-rated reports highlighted incomplete recruitment checks, missing references, DBS concerns, expired training, poor appraisal systems and inadequate competency assurance.

Particularly concerning examples included staff starting work before appropriate checks were completed, lack of oversight of professional registrations and uncertainty around staff competence.

These issues frequently overlapped with wider governance failures and workforce pressures.

7. Access, communication and patient experience concerns are increasingly visible

September reports highlighted significant concerns around patient access. Common themes included poor telephone access, difficulties using online systems, delays in appointments, poor communication regarding results and referrals, and patient dissatisfaction with responsiveness.

In some cases, practices struggled to demonstrate that services were accessible to working-age patients, carers or digitally excluded populations.

These findings suggest that access and communication are becoming increasingly important indicators of service quality.

8. Leadership culture remains a decisive factor in low-rated services

Several reports described cultures characterised by poor communication, lack of accountability, low morale, limited psychological safety and ineffective leadership relationships.

Where ratings were particularly poor, problems extended beyond operational processes into organisational culture.

This mirrors findings from previous quarters and reinforces the importance of leadership capability, staff engagement and organisational trust.

3. Practical implications for GP practice and PCN managers

What to emulate from Outstanding practices

• Use data proactively to identify unmet need, risk and opportunities for prevention.
• Demonstrate measurable improvement through audits, reviews and outcome monitoring.
• Invest in health inequalities work that addresses real barriers within local populations.
• Build partnerships that create practical benefits for patients.
• Develop governance systems that generate learning and evidence improvement.
• Create tailored pathways for vulnerable groups rather than relying on standardised approaches.
• Strengthen staff wellbeing, leadership development and organisational culture.
• Treat community engagement as a core element of healthcare delivery rather than an optional activity.

What to prioritise to avoid Requires Improvement or Inadequate findings

• Maintain a robust governance framework with clear accountability and action tracking.
• Ensure incidents, complaints and audits result in documented learning and improvement.
• Review high-risk medicines systems, recalls, monitoring and safety-alert processes.
• Strengthen safeguarding oversight, coding, audits and staff training.
• Review fire safety, IPC, COSHH, Legionella and environmental risk management arrangements.
• Maintain complete recruitment records, competency frameworks and training compliance.
• Monitor patient access, communication and continuity of care.
• Address cultural concerns early, including communication, staff engagement and psychological safety.
• Regularly test whether governance systems work in practice rather than simply exist on paper.

Overall conclusion

The July to September 2026 reports show a widening distinction between organisations that actively use data, governance, partnerships and innovation to improve care, and those that struggle to maintain reliable oversight of fundamental operational processes. Outstanding practices increasingly demonstrate sophisticated, preventative and community-focused models of care. Conversely, most Requires Improvement and Inadequate findings continue to stem from failures in governance, leadership, safety oversight and organisational learning. For GP practices and PCNs, the strongest message from this quarter is that sustainable quality improvement depends not only on good clinical care, but on the systems, culture and leadership that support it.